HomeMy WebLinkAboutPermit Electrical 2006-9-27
SPRIN~D ZON L "bil. .
~-^.-::;::::J INITIALS (\..J IV\
. < A!.' DATE '-1 -2 7-0~
. I;"AJI SOURCE\l'v1 >,,>"i f'/? , ....-ry
, .
Date q -d...,~ 200Co.
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A, New Residential- Single or Multi-Family per dwelling unit. .
~ S'ervi~eIn~;ud~~' .'... . - .. . <-
1000 sq. ft. or less $\ 06,00
Each additional 500 sq. ft. or
portion thereof
ELECTRICAL PERMIT APPLICATION
City Job NumbeLc-m.?.rJd.p - ('j Ad,. <.
. I. : LOCATION OF INSTALiATION: -. . .~.,.
\ DC;;~' t~t'L1r;\aif"- ......'
LEGAL DESCRIPTION: .L" LJ _ ~ ,
3 lIvCl.d-\$ TbV (\W..X'
JOB DESCRIPTION:
no3>~(p 4-1 OD 30 I
Permits are non-transferable and expire if work is
not started within 180 days of issuance or if work is
Suspended for 180 days.
.-~, - ',.,- -.-P,. ','_ - :___ - . '"",.-- ." ...
2. ,C()NTRACrO!?: INs.rALi4TI(Jl'f.ONLY~.
_4.... .. ,.__ _..4 ~.. _. '-"" ___' -,"-'
rJ., R~;(~l ~ f'jf!L'/~
//93
Electrical Contractor
Address
PD
I< ,")A.
9?Y;J../"
City , ~fl;A" 1,,"/ (
Phone '<%9t' - 7"Y't",
Supervisor License Number .2 9'71) - S
Expiration Date /0- LJI- 07
Constr. Contr. Number /5 'lb? 7
Expiration Date
7" - IS - /;;)("
Signature of Supervising Electrician
f]AJL~
Owners Name Let) ~(\~f')~\t....
Address \ O<.A 0 \ Li'I (l ~ :\-'
Cir&u~t / Phone 141 - '\ \g(~
OWNE~ }dSTALLATION
(l!rt
,
The installation is being made on property I own which
is not intended for sale, lease or rent.
Owners Signature:
Inspection Request: 726-3769
3, ,cOMPLETEFEESCHEDULEBELOW
.,;.;. '
$ 19.00
. Each Ma~n~!"e or
Modular 'tm~~~f\lI\'f g~All EXPIRE IF ~5.~ORK
Feed~~ ' . AUTHORIZED UNDER THIS I't~.MIT IS N~l .".
B. :}e~'~~.'iJtltJlf~~eN~E~~ji}lffii~rilM1QQh~~ g~eloc~tion: . .
HJV 180 DAY PERIOD.
200 Amps 8t'less
20 I Amps to 400 Amps
40 I Amps to 600 Amps
60 I Amps to 1000 Amps
Over 1000 AmpsNolts
Reconnect Only
$ 63.00
$ 75.00
$125.00
$163.00
$375.00
$ 50,00
r" -'... .--.,- -- . ~ -.. . -.'. - . "
C. :,':Tcmporarr Services or Feeders .
. . -' '.. . 'ArTEN'rIUI~:lJregon la~ r~q~~es you IV-
Installation, AI~~tiwlrQ.~f!tJ'!9sttp!l!d by the Oregon Utility
200 Amps or l~tilication Center. Those$-QQ;,QParA ~"t fnrt~
20 I Amps to 4txA1Jijs952-o01-0010 throl$Ji9il1O\R Q!\:MJlL
401 Amps to 6W~m~ou may obtain COPS1!lOlOOhe rolM h~
Over 600 Amps o~.l!~b~g,;~~ ~,?eI1IC!'a~~&!e:,t,he telephone
O 'B . h. C' 'f1,Ut M'dl;\r tortne cr. .."..... Utility Notification
, ranc IrCUl s "~-t I. . .
C_. _ _'. -. __, ar s 1-800-332~2344). . ..
New Alteration or Extension" Per Panel
One Circuit /
Each Additional Circuit or with
Service or Feeder Permit
$ 43.00
48
~
2
$ 3.00
...~ - ~
E. '.i~.s~~~la~~;otis, (Servic~/f:ede~ n~t Inciuded) -Ellch Installation'
Pump or irrigation $ 50.00
Sign/Outline Lighting $ 50.00
Limited EnergylResidential $ 25.00
Limited Energy/Commercial $ 45.00
Minimum Electric Permit Inspection Fee is $45.00 + Surcharges
~1. (JO
8% State Surcharge 3 .9-;).
10% Administrative Fee '-I . 't 0
5% Technology Fee Q) ..i..Q
TOTAL 11. (PO. d"1
Shared Drive(T:)IBuilding FonnsJEleclrical Pcnnit Applic.:J.tion 8-06,doc
4.SUBTOTALOFABOVE
_'-A
,,' ~ "".~., _. ... ...-
225 Fifth Street
Springfield, Qregon 97477
541-726__3759 Phone
. ~:Q~~
Wi;:. '
clil'f Springfield Official Rcccipt
~opment Scrvices Department
Public Works Departmcnt
Job/Journal Number
COM2006-0 1223
COM2006-0 1223
COM2006-0 1223.
COM2006-0 1223
COM2006-0 1223
Payments:
Type of Payment
CreditCard
cReceinll
RECEIPT #:
2200600000000001355
Date: 09/27/2006
Description
Add, Alter, Extend Circ
Add, Alter, Extend Circ Ea Add
+ 5% Technology Fee
+ 8% State Surcharge
+ 10% Administrative Fee
Paid By
C. PERKINS ELECTRIC
Item Total:
Check Number Authorization
Received By Batch Number Number Bow Received
njm
093972 Fax
Payment Total:
Page I of J
8:44:23AM
Amount Due
43.00
6.00
2.45
3.92
4.90
$60,27
Amount Paid
$60.27
$60,27
9/27/2006